Fall 2018 N725: Translational Research Method Report

This report analyzes two articles focused on translational research methods related to post-stroke depression. The first article examines the effectiveness of a care management program (Activate-Initiate-Monitor) in treating post-stroke depression, highlighting the problem of under-treated depression and its impact on recovery. It details the translational framework, including knowledge creation from previous studies, problem identification, adaptation to local knowledge, assessment of facilitators, implementation of the intervention, and evaluation of outcomes. The second article proposes a new stroke-specific screening tool for depression, addressing the need for improved identification methods. It discusses the limitations of existing tools and presents the development of a new tool (HRQOLISP-26) for assessing post-stroke depression. The report details the translational framework used in the study, including knowledge creation through systematic reviews, identification of gaps in existing tools, and the adaptation of knowledge to create a more effective screening method. Both articles emphasize the potential impact of improved methods on patient outcomes and healthcare practices. The report follows the guidelines for a final translational project paper, as outlined in the provided assignment brief, covering problem statements, background information, aims, translational frameworks, methods, challenges, anticipated results, and potential impacts.

Running head: TRANSLATIONAL RESEARCH METHOD
Translational Research Method
Name of the Student:
Name of the University:
Author Note:

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First article: “Care Management of Post Stroke Depression a Randomized, Controlled Trial”

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Statement of the problem- Post stroke depression can be described as a feeling of hopelessness
that interferes with the quality of life and functioning of life. Thus, if it is not treated well than
the post-depression can slow down the process of recovery. Depression can set in weeks of
months after the occurrence of stroke and it can prevent the process of rehabilitation and
recovery and it impacts the way of life. There is a combination of factors that all together can all
together have a life changing impact on the patient. Damage to the brain after stroke is common
and it has a life changing effects on the social factors, genetics that all together contributes to
depression.
Background of the Problem- Post stroke depression occurs in one in every 3 patients or stroke
survivors. The stroke survivors are associated with reduced recovery, like after the occurrence of
myocardial infarction depression follows. The post stroke depression is associated with the
increased healthcare utilization, increased mortality, and subsequent events of cardiovascular
events. Post stroke depression is a disabling and is a prevalent disorder and yet the several
evidences of effectiveness of the treatment procedures of post stroke depression are all
inconclusive.
Aim- The main objective of the study is to determine the effectiveness of the care management
programme called the Activate-Initiate-Monitor care management for the treatment of the
patients that are suffering from the post stroke depression.
Translational framework-
Knowledge creation- knowledge is created through the different previously conducted
studies and such studies included the controlled clinical trials, randomized control trials and their

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evaluation. A Cochrane meta-analysis was also conducted which concluded the previously
suggested treatments were insufficient
Identification of the problem/determination of the gap- The problem identified by the
authors emphasized mostly on the lack of proper treatment options for the post stroke depression
patients. All the previously conducted studies were unable to provide a comprehensive method of
treating post stroke depression and the efficacy of the process were not up to the mark.
Furthermore, a Cochrane meta-analysis on the post stroke depression treatment trials showed that
the treatment procedures were insufficient and the remission of the depression after stroke.
Adapt to the local knowledge- The study is designed so that it can help the patients with
post stroke depression. The previous studies lacked the proper care management plans or the
proper intervention plan. The local knowledge pertaining to the previous practices that were
previously applied on such patients are used in the study.
Assessment of the facilitators of the knowledge use- The authors emphasized on the
intervention plan of Activate-Initiate-Monitor intervention was found to be effective within the
patients regardless of the gender or the age and it affected the white and the black subjects
similarly.
Implementation of the intervention- The intervention chosen for the patients suffering
from the post stroke depression is the Activate-Initiate-Monitor intervention. This intervention
was conducted by the nurse care managers that are under the supervision of the study physicians.
The intervention consisted of the three main steps: 1) the stroke survivors and their families were
activated and were made understand of the depression treatment and diagnosis; 2) initiation of
the antidepressant medication; 3) monitoring the effectiveness of the medication.

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Evaluation of the outcomes- The usual care group and the intervention differed on the
major baseline measures. The results of the study indicated that post stroke depression can be
treated effectively by the standard antidepressant medications for the treatment of depression.
Translational methods- The strategy employed in the search approach includes survivors of the
stroke that received the care management for post stroke depression.
Anticipated challenges and strategies to facilitate success- The challenges of the study can be
unwillingness of the patients to take up the medication at the proper time intervals. The
medications might not work in some of the patients. The strategy can be to promote the benefits
of having the medicine at the proper time. While complication with the certain type of medicine
in some patient can be altered with a different medicine.
Anticipated result- The usual care model is less effective in comparison to the Activate-Initiate-
Monitor intervention.
Potential impact- The providers must first consider the screening of the active depression
among the high risk groups and along with it must also provide guidelines based on the treatment
of depression.

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Second article- Proposing a new stroke-specific screening tool for depression: Examination of
construct validity and reliability

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Statement of the problem- The burden of stroke is increasing at a rapid pace and due to it
disability and morbidity is also rising. Majority of the morbidity occurs due to the depression,
although is treatable but if left untreated and unidentified can be fatal.
Background of the problem- The recommendation for the diagnosis of the post stroke
depression should be based on the examination of the semi mental state. The clinical criteria
include the statistical manual of mental disorders and the diagnostic manual of mental disorders
to diagnose stroke that have depressive or episodic features. There remains a difficulty in the
identification of the appropriate method of screening the post stroke depression in the wide array
of the tools.
Aim of the study- The optimal tool which is required for the identification of the depression
after stroke is yet to be identified. The study presents a context specific screening tool for the
identification of post stroke depression. The reliability and the validity of the screening test is
conducted within the stroke survivors.
Translational framework-
Knowledge creation- Knowledge is created by conducting a systematic review on the 27
different tools that were used in the screening of the post stroke depression. It has been found
that none of the measures were able to provide sufficient results among the stroke survivors
because many of them were false positives. Tools were unable to meet the clinical and the
psychometric utility criteria in the reviews. The tools are either no longer used in the test the post
stroke depression or require the assistance of the specialists in conducting such tests.
Identification of the gap- The several systematic reviews conducted with the tools
revealed that the post stroke depression is capable or sufficient enough to provide the desired

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results as required in the identification of the post stroke depression. The tools are found to be
either very complicated requiring the assistance of a specialist or is no longer used in the
screening process. This knowledge gap created an interest in the authors to conduct a study on
the post stroke depression identification tool.
Adaptation of knowledge to local context- The study is designed so that it can provide a
comprehensive tool for the identification of the post stroke depression though a tool. It was
found by the authors that a scale named Hospital Anxiety and Depression rating scale is
psychometrically sufficient in identifying the post stroke depression within the stroke survivors.
However, it is important to note that the acquisition cost of the tool is huge and thus has very
limited usage. Thus, the optimal tool remains to be identified.
Assessment of the facilitators to knowledge use- The lack of a tool that can be widely
used and have less acquisition cost led to the usage of knowledge and framing of a screening tool
that will be used for post stroke depression. While the newly designed tool will facilitate its
usage in a patient controlled, transnational, cross cultural sample and it will be a comprehensive
model.
Implementation of the intervention- A new tool was used which is called “HRQOLISP-E”
and it has been designed from the Health Related Quality of Life in Stroke patients (HRQOLISP-
26). This tool will be used in the identification of the post stroke depression.
Evaluation of the outcomes- The evaluation of the outcomes will be based on the
evaluation of the stroke survivors with the Health Related Quality of Life in Stroke patients
scale.

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Anticipated challenges and strategies to facilitate success- The challenges pertaining to the
usage of the tools for the identification of post stroke depression involves the usage of tools that
are either obsolete or are very expensive. The best strategy is to frame a tool that will be easy to
handle and have less complexity.
Anticipated result- The study itself is based on devising a strategy or a tool which will surpass
all the old and complex tools that were previously used in the diagnosing the stroke survivors.
Thus the newly developed scale will perform in a better way in comparisons to all the previous
tools and it will prove to be helpful in diagnosing the post stroke depression in stroke survivors.
Potential impact- The new HRQOLISP-26 is designed in an empirical way so that it can
measure the stroke in a specific way and thus it will have a good construct validity. The new
instrument will be much better in comparison to the old ones in diagnosing post stroke
depression in stroke survivors.

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References
Ojagbemi, A., Owolabi, M., Akinyemi, J., & Ovbiagele, B. (2017). Proposing a new stroke-
specific screening tool for depression: Examination of construct validity and reliability.
eNeurologicalSci, 9, 14-18. DOI: http://dx.doi.org/10.1016/j.ensci.2017.10.002
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2016). Translation of evidence into
nursing and health care. Springer Publishing Company. Retrieved from:
https://books.google.co.in/books?
id=vDCoCwAAQBAJ&pg=PA354&lpg=PA354&dq=Part+V:
+Translation+Exemplars.&source=bl&ots=ZZz5Zddr9I&sig=141Tc9jN9Y4SPBgdcKW
zj3b24b8&hl=en&sa=X&redir_esc=y#v=onepage&q&f=false
Williams, L. S., Kroenke, K., Bakas, T., Plue, L. D., Brizendine, E., Tu, W., & Hendrie, H.
(2007). Care management of poststroke depression: a randomized, controlled trial.
Stroke, 38(3), 998-1003. DOI: 10.1161/01.STR.0000257319.14023.61